A new study from China shows that women who have experienced induced abortion have omnipresent mental health problems during a subsequent pregnancy. It also confirms that adverse mental health effects of induced abortion are far more severe than those of miscarriage and they persist longer.

The most recent study published in the Bulletin of Clinical Psychopharmacology by Z. Huang and colleagues from the Anhui Medical College in China finds that women who had an induced abortion a year or more prior to the pregnancy were 49% more likely to experience depression and 114% more likely to suffer from anxiety in the first trimester of subsequent pregnancy compared to women with no abortion history.

Women who had an induced abortion less than one year prior to the pregnancy experienced a 97% increased risk of anxiety in the first trimester and 64% greater risk of depression in the second trimester. Women who experienced spontaneous abortion one year or more before the pregnancy, however, did not face greater risk of anxiety or depression.

The Chinese study looks at 6,887 women, more than 40% of whom had experienced at least one induced abortion. Maternal education, income, place of residence and body mass index (BMI) scores are controlled for in order to identify the independent effect of abortion on mental health problems during subsequent pregnancy.

In China, abortion is legal and available for women as a government service. The authors argue that abortion plays an imperative role in achieving China’s goals of population stability through the one-child policy.

In rural areas, a second child is sometimes allowed after five years, especially if the first-born is a girl. In urban areas, couples often choose to terminate the first pregnancy, knowing they are only allowed one child. The densely populated Anhui province, where the study was conducted, is a case in point. Partly as a result of widespread abortion, it also has one of the highest gender imbalance ratios in China: more than 130 boys for 100 girls according to a British Medical Journal 2009 study on “China’s Excess Males, Sex Selective Abortion, and One Child Policy.” The natural ratio is 103 to 105 boys per 100 girls.

The new study adds to the rapidly growing literature on the effects of abortion on the mental health of women. Despite the widespread abortion culture in China, this study shows similar results to studies conducted in the United States, Australia, Norway, and South Africa. Many of these are available at the website WECARE, the World Expert Consortium for Abortion Research and Education (www.WeCareExperts.org ).

The study also finds that mental health problems in the first term of pregnancy following an induced abortion may have detrimental effects on the fetus. Dr Priscilla Coleman argues: “All the major body structures are formed during the 1st trimester and stress hormones may potentially harm the developing fetus.”

And finally, there are health policy implications. The study’s authors conclude: “Understanding the emotional responses after a pregnancy termination may enable health personnel to better distinguish those women who need extra help and follow-up and provide insight into the needs of these families at this critical time.”